EXECUTIVE SUMMARY / In one short paragraph please describe this project and what it has achieved.
We will use this in any future publicity material.

People with dementia living in their own homes in the community are frequently considered to be at risk of wandering and the police regularly assist in searches for people who have wandered or become lost and disorientated. The Fife Telecare Development Programme (TDP) promotes the use of Telecare to support frail and vulnerable people to remain in their own homes and communities.Global Positioning Systems (GPS) enable the emergency location of a person who has become lost or disorientated. This project piloted the use of GPS systems to assist people with dementia to continue activities independently whilst reassuring their carers.

PLANNING / · a clear rationale, defined processes and focus on stakeholder needs
· contributes to organisation’s goals, community plan and SOA, and national policy context

During Telecare Development Programme (TDP) awareness and training sessions, frontline workers in health and social care regularly raise concerns about wandering by service users with dementia. At the same time TDP staff were researching GPS technology and its developing potential in this field.

TDP staff liaised with Fife Constabularyand an Inspector joined the planning team. He commented:“There are actually two aspects to this from a police perspective. Firstly, the ability of a family member of a person carrying a GPS device to access the system provides them with the opportunity to identify their vulnerable relative's locationwhich may lead to the person being located quickly,minimising any risks to them and negating the need for them to be reported to the police as missing. Secondly, persons suffering from dementia who are reported missing would be regarded as extremely vulnerable and any such report would generate an immediate response. This could potentially involve a large number of officers, including specialist officers, e.g. search teams and dog handlers and on occasion other agenciese.g. Coastguard, SAR helicopter. Should a person carrying an activedevice be reported missing, there iswithout doubtpotential benefit to the police.The primary concern of the police isthe safety and welfare of the missing personand any assistance available to allow them to be located quickly is welcome.”

TDP staff also involved Fife Council Social Work Service’s Out-of-Hours Service. The cost of conducting a search for a missing person could be £10 - £20 per person, per hour in terms of Social Work Service salary costs alone.

The Safer Walking pilot aimed to:

  • determine whether GPS technology can help people affected by dementia to continue living independently by managing the risks associated with disorientation and wandering
  • make recommendations for mainstream use of GPS technology.

To achieve these outcomes, the project planned to work in partnership with service users, their family carers and other stakeholders (e.g. Fife Constabulary, Social Work Out-of-Hours Service, the Community Alarm Service, Contact Centre). The team would purchase and familiarise themselves with a representative selection of GPS technology; demonstrate GPS devices to health and social care staff; identify and recruit participants for the pilot, provide ongoing training and support to participants and their family carers and liaise with partners and other Fife Council services in raising awareness of the pilot and its potential outcomes.

The GPS pilot supports the strategic goals of a number of Fife strategies which aim to shift the balance of care and address the aspirations of the majority of people to be supported to live in their own homes (Fife Partnership SOA; HEAT targets; Older People’s Joint Commissioning Strategy; Fife Council Big 8; Dementia Strategy; Carers Strategy).

DELIVERING / · implemented in all relevant areas and across all the required stakeholders
· carried out in a structured and logical way , using robust and sustainable methods

The Safer Walking pilot was planned to run for an initial 9 months, starting June 2009, with 10-15 participants. It was overseen by the TDP Board which represents interests across the Fife Health & Social Care Partnership, including the Social Work Out-of-Hours and Community Alarm Services. Fife Constabulary also came on board and linked the pilot to their Control Room. The pilot was promoted to workers in health and social care during training and awareness sessions. Interest from members of the public was generated by articles in the local press. Nineteen participants were recruited and they and their carers were visited by TDP staff and the devices were demonstrated.

Participants were issued with one of two types of GPS devices – Buddi and Teltonica. When they were out, their whereabouts could be ascertained whenever carers were concerned. Carers could access a secure website and see a map or aerial photograph showing the precise location (also given as a grid reference) of the device and therefore their relative. With one of the devices, carers who did not use the internet could telephone a secure response centre to obtain the location of their relative. The other device was supported with user accounts for family carers who could receive SMS messages. Both devices also had a “panic button” for participants to use if they felt disorientated or concerned although few participants had the capacity to use this facility.

Early on in the project’s development it was recognised that the involvement of carers was a key requirement – the technology simply locates the devices themselves so there had to be a way of ensuring that the participants carried their device whenever they went out. The devices also have to be charged up on a daily basis and carers took responsibility for this. Theseare limitations of the technology which currently would not assist in situations where people with dementia who live alone may wander, particularly at night. Other limitations include: the location is updated at five minute intervals and, near a service user’s home it can give a “false” location by showing them as still out when back in the house – this was fully explained and demonstrated to carers in order to avoid lack of confidence in the device; the location cannot be updated when the device is inside a building so the user’s position will be shown at the last location before entering the building - this may be an issue in town centres where the user might enter a shopping centre, railway station, etc. and, again, clear briefing of carers addressed this; also of importance when locating a user in a town centre (or any other crowded area) would be the need for help to identify them if the police were involved in the search - photos and descriptions were provided with the user’s consent; finally ethical concerns expressed by a few Social Workers were addressed positively by promoting Scottish Mental Welfare Commission guidelines and communicating Alzheimer’s Scotland’s endorsement of the use of GPS devices.

INNOVATION + LEADING PRACTICE / ·Demonstrates leading practice
·Achieves genuine innovation or new ways of working

Fife is one of a small number of Councils in Scotland trialling GPS for vulnerable service users and implementing this technology. Of particular importance in Fife has been the partnership approach that has been taken to delivering the service. This includes working with Fife Constabulary at an operational level involving information sharing and training. There has also been partnership working with the two companies whose devices were tested during the pilot – lessons learned have been fed back to the companies to assist in the further development of this technology and the improvement of their user guides. This is also occurring through joint working with other Councils.

The pilot ran to the end of March 2010. It was then extended to explore further technical developments (e.g. improved battery life, alternative options for wearing the device and decreasing device size) as new devices become available and need to be assessed. GPS locationis now being established as a service accessible through Fife Council Social Work Service and delivered by the Community Alarm & Telecare Service. This entails refining assessment guidelines and data collection protocols. In the longer term there may be a requirement to link the GPS Service to the Community Alarm Service so that the Council’s Contact Centre could take on emergency location.

RESULTS + IMPACT / · a convincing mix of customer perception and internal performance measures
· clear line of sight to the delivery of the Single Outcome Agreement
· a full range of relevant results showing improvement over time

The Safer Walking pilot was monitored in the following ways: 1. Incident recording – all activations of the devices or searches initiated were recorded by TDP staff as were any problems with the devices (these were also reported to the companies for action); 2. Regular contact was maintained with participants and their carers throughout the pilot; 3. Qualitative data, e.g. on relieving carer stress, was collected through interviews with participants and their carers.

Feedback from participants and their carers, as well as from health and social care workers involved with these service users, was received throughout the pilot.The post implementation review took the form of one-to-one structured interviews with participants and their carers.

  • Of the nineteen participants, 16 families have been trying out the devices for long enough to provide feedback. Nine of these sixteen families cited the reduction in worry and anxiety associated with providing care for their relative as the principal benefit of using GPS technology.
  • Ten participants have for all or part of their time in the pilot continued to enjoy independent travel either by walking or by bus. One participant made almost daily trips by bus to other towns in Fife and to Edinburgh despite having a diagnosis of dementia which was previously giving great concern to the family.
  • Three carers of participants using the Halliday-James device were particularly reassured by the auto answer feature which enabled them to make a mobile phone call to the device wearer without there being a need for the wearer to press any buttons to answer. The device can be programmed to answer automatically in loud speaker mode after a set number of rings enabling the wearer to hear the voice of their carer. The participants had previously lost the ability to operate even the simplest of mobile phones.
  • Two carers have welcomed the ‘man down’ feature of the Buddi device that uses accelerometer technology to detect that a fall has occurred. One of these carers talked about the anxiety of providing support to both elderly parents, one a participant in the pilot, from her home near London. She received an alert when her father stumbled and fell when out for a walk along a beach. No harm was done and the daughter happened to be back in Fife and with her father at the time. Her comments were “Thank you for setting this up. It will ease our minds tremendously”.

There have been a small number of problems during the pilot with either the technology or the system for acting on alerts. Lessons learned from these issues have been incorporated into future plans. In the absence, so far, of a real emergency requiring the use of GPS technology to locate a missing person, the dominant outcome as perceived by the majority of carers is of a reduction in stress and anxiety.

The pilot has determined that GPS technology can help some people affected by dementia to continue to enjoy activities independently and give them and their carers the confidence to facilitate this. The case studies below show that the wellbeing of both participants and their carers has been improved. The pilot has also embarked on developing criteria for the mainstream use of GPS technology in care services.

Feedback from carers suggests that there is a strong correlation between having use of a GPS device and a feeling of confidence and security for their relative.

The devices themselves cost under £300 to buy (rental options are also available but are best for short trials). One device is supported by a staffed monitoring centre which costs £20 per calendar month to subscribe. Small call charges (£2 per calendar month) are also incurred. The maximum cost for initial purchase and one year’s monitoring would be under £540, a small price when set against the possible costs of major search operations or restricting people’s activities.

Case Studies

1. Mr A., an older man with early onset dementia lives with his wife, who is also his main carer. He enjoys travelling around Fife and to Edinburgh by public transport. Prior to receiving the GPS device in May 2009, his family were becoming increasingly anxious about ‘letting him go out on his own’. His daughter feels it has been “fantastic to know where he was (and where he had been) when out.”

2. Mr M., an older man with dementia has recently moved to sheltered accommodation but previously enjoyed daily walks. His care worker reports that he is now in the habit of putting his device on whenever he goes out and is gaining confidence in taking short walks every day.

3. Mrs S. is a fit, active older woman with dementia who regularly runs and cycles around her home town. Her husband was anxious that she might one day fail to make her way home, especially since he had an operation which limited his ability to accompany her. She has had her GPS device for six months and, although she will shortly be moving to a care home due to the progression of her illness, she will continue to use her GPS device.

4. Mrs M, a middle-aged woman with dementia, lives with her husband who has given up his job to care for her full time. She takes her dogs for long walks, sometimes on her own and sometimes with Mr M. She was losing confidence in her ability to walk on her own. The following comments from her husband illustrate the impact of using the device:“Now that it is set up to suit us I think the unit is excellent. The panic button now works with a short press and C can use it OK. The web site tracking is excellent and very reassuring if she is gone longer than expected.” (June 2009)

“I still use the tracker but in a purely passive way, as long as C has it I know where she is but she would be unable to use it (the panic button) in an emergency. I think that a simple GPS device with no buttons or lights flashing on it is the best option for someone at C’s stage. It looks like she will struggle to go out independently quite soon but she may get more inclined to wander as the illness progresses, therefore there will still be a need for a GPS device” (January 2010).

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